| NPI | 1295496388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R80217) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 113661-01) |
| Enumeration Date | 2022-01-01 |
| Last Update Date | 2023-09-19 |